困难气管拔管的预测因素及拔管策略的研究进展

Predictive factors and extubation strategies in difficult tracheal extubation

气管拔管是全身麻醉中的关键环节,拔管过程发生意外往往造成死亡或脑损伤等严重后果。随着各种先进拔管工具和流程的更新,拔管方案变得更加多样和完善。然而到目前为止,仍没有单独一种绝对可靠的预测方法和拔管策略可以应用于所有困难气管拔管。麻醉医师仍须全面而仔细地评估患者后按照流程个体化拔管。文章总结近年困难气管拔管的预测因素及拔管策略的研究进展,包括气道评估、高危拔管评估、其他工具和方法的评估来预测困难拔管,介绍相关拔管流程和各种拔管工具、药物等。

Tracheal extubation is a critical step in general anesthesia.Accidents during extubation often result in serious con‑sequences such as hypoxic brain injury or death.With the update of various advanced extubation tools and algorithms,the extubation programs have become more diverse and complete.However,until now,there is still no single absolute reliable prediction method and extubation strategy that can be applied to all difficult tracheal extubation.The anesthesiologist still needs to comprehensively and care‑fully evaluate the patient and follow the program of individualized extubation.This review summarizes the predictive factors of difficult tracheal extubation and the research progress of extubation strategies in recent years,including airway assessment,evaluation of high‑risk extubation,and evaluation of other tools and methods to predict difficult extubation.Meanwhile,we introduce relevant extuba‑tion algorithms and various extubation tools,drugs,etc.